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A Reader Asks ...

Dear HIS Pros: If a hospital plans to implement most core clinical applications, do you recommend a big-bang approach of turning everything on at once or an incremental one that involves doing a few applications a year over 2-3 years?

Vince Ciotti, Principal, HIS Professionals

Generally, it’s best to convert the least you have to at any one time, to maximize the quality and minimize the trauma. “Big Bang” conversions often lead to resumes. Our usual recommendation is to implement a new HIS in 3 phases:

Phase I = first convert all the apps currently running on your old system, for the following reasons:

1. you can turn off that costly maintenance on your old system asap and save money
2. users of those apps are already familiar with an HIS in general and are PC literate
3. you clean up all the “silly” bugs and problems with users who know they are inevitable
4. these apps can go live fairly quickly since both IT and users have automated them before
5. greatest chance for an early success (minimal problems) before the big challenge comes in:

Phase II = implement new apps, which in most cases today are nursing documentation, med. admin., and CPOE; the reasons:

1. these new clinical apps have HITECH stimulus funds attached, so they have to go well
2. getting basic bugs out of existing apps increases the likelihood for success in these critical apps
3. allows far more time for the heavy lifting of designing new screens and reports never automated before
4. makes sure nurses are already experienced users from Phase I, so they can be MD “helpers” for CPOE
5. allows plenty of time (during Phase I) for “clinical transformation” and clinical work flow analyses

Phase III = optional apps, which aren’t tied to ARRA funding, hence no hurry, and which you may or may not install depending on how well the vendor performs in Phases I and II… examples of these apps are:

1. Financial/administrative systems like:
   • Executive Information Systems (dashboards)
   • Document imaging (better with COLD feeds from new clinical apps anyway)
   • Decision Support (modeling)
2. “Minor” clinical apps with no ARRA dollars attached to them, like:
   • Nurse staffing & scheduling
   • OB, OR and ED (”minor” is in quotes!) – all very tricky specialty areas with complex interfaces
   • Case management, social work, QA, etc.

Within each phase with clinical apps, some hospitals try to stagger nurse stations one at a time, e.g.: starting with a single Med/Surg floor first, then migrating the system to other Med/Surg floors, then Peds, OB, etc. This makes sense with a very large hospital (400+ beds), but draws hysterical laughter from Critical Access Hospitals. The problem with this approach is transfers, where a patient is admitted to a paper floor then gets transferred to an EMR floor, or vice-versa. Again, the larger the hospital, the more this approach might make sense; the smaller the facility, a “Big Bang” among floors might be far less painful.

Note, these are general rules: every hospital is unique so, based on individual circumstances, many variations occur. The key is having experienced implementation personnel from the vendor advising on what they have learned in the past. Don’t ever ask vendor execs or marketing types: they’re eager to get everything live ASAP to book the revenue and claim another install; ask your hospitals’ implementation project manager in private with no sales types in the room, and you have a good chance of getting solid advice. You did insist on meeting them during your selection process, didn’t you? They have to live through the pain with you, so want as little of it as you do!

Tags: Ask the Pros

This entry was posted on Tuesday, June 8th, 2010 at 9:04 AM and is filed under Change Management/Implementation, Vendor Management. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.